hypopituitarism

Question 1

what happens to the pituitary gland as we get older

Answer 1

it decreases

Question 2

pregnancy causes a change in pregnancy

Answer 2

yep, it gets bigger due to the proliferation of lactrotophes

Question 3

compression of optic chiasm leads to what type of eye issue?

Answer 3

bitemporal hemianopsis (not seeing anything from the sides

Question 4

Rare to see compression of internal carotid.

Answer 4

yep

Question 5

Embryolgicaly, anterior pituitary derives from _______________ as Rathke’s pouch. Posterior pituitary from __________ as outpouching from floor of third ventricle.

Answer 5

Embryolgicaly, anterior pituitary derives from oral ectoderm as Rathke’s pouch. Posterior pituitary from neural primordial as outpouching from floor of third ventricle.

Question 6

From the pituitary, venous blood drains into

Answer 6

inferior petrosal sinus.

Question 7

posterior pituitary “bright spot”

Answer 7

indication that there is a disease process happening

Question 8

deficiency most common cause for hypopituitarism associated with GH, Prol, TSH deficiency and variable gonadotroph. Can be associated with nl, hypoplastic or hyperplastic pituitary.

Answer 8

PROP 1 (profit of pit-1)

Question 9

Growth retardation
Decrease in energy
Constipation
Cold intolerance
Dry skin
Weight gain

Answer 9

TSH DEFICIENCY

Question 10

Weakness
Weight Loss
Fatigue
Dizziness (standing)
Pallor
Hypoglycemia
Nausea/Vomiting
Circulatory Collapse

Answer 10

ACTH DEFICIENCY

Question 11

craniopharyngioma is a

Answer 11

non-functional tumors

Question 12

Infarction of the pituitary in pregnancy

Answer 12

sheehan’s syndrome

Question 13

Pituitary insufficiency (hypopituitarism) may arise from (2)

Answer 13

congenital defects or acquired disease of the pituitary or hypothalamus.

Question 14

Pituitary hormone levels may be inappropriately normal relative to target hormone levels in hypopituitarism.

Answer 14

yep

For example, a normal TSH may be seen with a low free T4 in a patient with untreated central hypothyroidism.

Question 15

To test ACTH reserve directly, an insulin tolerance test can be done (also tests GH reserve). Metyrapone can also test ACTH reserve… why?

Answer 15

which inhibits the last step in cortisol synthesis

Question 16

A dehydration test can be done to assess for central diabetes insipidus where ADH will be _____ with a high serum osmolality and low urine osmolality.

Answer 16

low

Question 17

The presence of diabetes insipidus, slightly elevated prolactin and one or more anterior pituitary deficiencies suggests involvement of the ______________

Answer 17

pituitary stalk or hypothalamus.

Question 18

__________________ must be replaced first if multiple hormones are deficient. Thyroid hormone would be next. Gonadal hormone replacement and growth hormone replacement would depend on the individual patient.

Answer 18

Glucocorticoids

Question 19

Normal adenohypophysis contains a heterogeneous, nested population of ___________ secretory cells that on H&E stain are (1) (cytoplasmic granules stain with eosin, which is an acidic dye; make GH and Prolactin), (2) (cytoplasmic granules stain with hematoxylin, which is a basic dye; make ACTH, FSH/LH), or (3) (make any of the hormones but are sparsely granulated)

Answer 19

neuroendocrine-type

1. acidophilic
2. basophilic
3. chromophobic

Question 20

Neurohypophysis consists of axons and glia, no ___________________

Answer 20

secretory cell bodies

Question 21

The adenohypophysis has a large functional reserve.

Answer 21

yep

Question 22

Pituitary apoplexy is an

Answer 22

infarcted pituitary adenoma.

Question 23

Common cancers, e.g. breast and lung, frequently metastasize to the pituitary and can selectively affect the ________________ causing diabetes insipidus.

Answer 23

neurohypophysis,

Question 24

Empty sella syndrome is an

Answer 24

intrasellar arachnocoele

Question 25

Differential dx of intrasellar cysts includes (1) (squamous, cuboidal, columnar, sometimes respiratory lining, sometimes with goblet cells), (2) (looks like complete skin with dermal appendages) (3) (looks like epidermis without dermal appendages).

Answer 25

1. Rathke cleft cyst
2. dermoid cyst
3. epidermoid cyst

Question 26

Small asymptomatic infarcts occur in various conditions

Answer 26

sickle cell disease and hypovolemic shock

Question 27

Large infarcts causing functional impairment are most common in __________

Answer 27

obstetric shock (Sheehan’s syndrome).